Healthcare Provider Details

I. General information

NPI: 1114702479
Provider Name (Legal Business Name): JOHN YASHOU DO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18182 US HIGHWAY 18 STE 107
APPLE VALLEY CA
92307-2200
US

IV. Provider business mailing address

20258 US HIGHWAY 18 STE 430-401
APPLE VALLEY CA
92307-6197
US

V. Phone/Fax

Practice location:
  • Phone: 760-515-4003
  • Fax: 760-515-4503
Mailing address:
  • Phone: 305-725-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN YASHOU
Title or Position: PRESIDENT
Credential: DO
Phone: 305-725-7624